Proposing national diagnostic reference levels for electrophysiology studies and catheter ablation procedures in Bulgaria.

Introduction: The implementation of diagnostic reference levels (DRLs) is an essential tool for optimisation of the routine practice, better management of patient exposure while maintaining sufficient image quality. National DRLs for electrophysiology (EP) procedures are not available in our country.

Purpose: The main purpose of the study was to propose, for first time in Bulgaria, national DRLs (NDRLs) for EP studies and ablation procedures of two different levels of complexity.

Unusual site of origin of a non-automatic focal right ventricular tachycardia.

Focal right ventricular tachycardia is relatively uncommon. It usually arises from specific anatomic locations. A 59-year-old woman with a structurally normal heart and an automatic cardioverter-defibrillator implanted beforehand presented with drug-resistant incessant ventricular tachycardia for which 1786 anti-tachycardia pacing therapies and 119 shocks had been delivered.

Selective slow pathway ablation using transseptal approach in a patient with surgically corrected partial atrioventricular canal defect and atrioventricular nodal reentrant tachycardia of the common type.

A 26-year-old woman with partial atrioventricular (AV) canal defect surgically closed with pericardial patch in a mode that the triangle of Koch had become part of the left atrium underwent successful slow pathway ablation for slow-fast AV nodal reentrant tachycardia. Transseptal approach was used because of the atypical post-operative anatomy. Transseptal catheter ablation of the slow pathway can be a reasonable and safe alternative in patients subjected to this type of operation.